The patient's initial presentation was radiographically concerning for vascular sarcoma given the presence of an intracardiac mass lesion and a mass involving the right hemidiaphragm
Caption: Figure 1: Chest radiograph in AP projection showing elevation of both domes of diaphragm with interposition of colon between liver and right hemidiaphragm
The plaques removed from the right hemidiaphragm
and liver surface predominantly showed corded epithelioid and spindle cells embedded in a hyalinized collagenous stroma with rare atypical glands.
Three animals were stimulated with bilateral Permaloc electrodes lateral to vena cava: two were stimulated with bilateral pair 2 cm dorsal for vena cava and one was paced with single electrode on right hemidiaphragm
The x-ray revealed free air under the left hemidiaphragm
suggesting a perforation.
EPP is a radical surgical procedure involving complete removal of the ipsilateral lung along with the parietal and visceral pleura, pericardium with portions of the phrenic nerve, and the majority of the hemidiaphragm
However, the weakened hemidiaphragm
is displaced into the thorax, which can compromise breathing.
One such mechanism is associated with increased doming of the right (dependent) hemidiaphragm
in right side-lying due to abdominal encroachment which places the diaphragm in a mechanically-advantageous position, potentiating an increase in caudal movement during inspiration (Barach and Beck 1954).
Chest x-ray again showed right midlung atelectasis and chronic right hemidiaphragm
However, the association with limb weakness of a motor neuron or anterior horn cell type, presence of an elevated hemidiaphragm
on chest radiograph, and a restrictive pattern of respiratory failure by pulmonary function testing suggest a central, poliomyelitislike etiology for respiratory failure in all other patients.
9 (*) Serious AEs reported included infection, nerve paralysis, hypersthesia, facial paresis, left vocal chord paralysis, left facial paralysis, left hemidiaphragm
paralysis, left recurrent laryngeal nerve injury, urinary retention, and low grade fever.
Perform four quadrant cell washings; inspect the small and large bowel; do a generous omental biopsy and an appendectomy for mucinous BOTs; perform random biopsies or Pap smear tests of the pelvic side walls, right hemidiaphragm
, and the paracolic gutters; submit all adhesions to pathology; palpate the paraaortic and pelvic nodes; and, finally, do a bilateral salpingo-oophorectomy and a total abdominal hysterectomy, except in those patients who are younger and want to preserve their fertility.